During my acquaintance with many of my co-practitioners, I have often noticed that there exists a good deal of controversies as regards the importance of the knowledge of pathology in the matter of selection of drugs. The orthodox school deny any necessity of bringing into account pathological changes in the system for determining the totality. They only depend on symptoms, both subjective, that is which the patient complains of; and the objective ones, which can be made out with the naked eye; while the other school regards pathological knowledge and changes as important as the symptoms themselves. I shall try to tell a few words in support of the latter view and cite some practical examples to support my statement.
Now what is Homoeopathy? “It is a therapeutic law whose expression is found in Similia Similibus Curentur, or let like be treated by likes”, the significance of which is known to all homoeopathic practitioners. The main principle is that the healing properties of a drug correspond to its disease-producing properties upon the healthy organisms.
When we administer a drug to a healthy individual it produces certain symptoms which can not be seen, can not be smelt, can not be touched, but can only be described by the patient. These are called subjective symptoms which may not have a pathological basis.
Besides these subjective symptoms, certain other systemic changes are produced which can be determined by physical examinations, such as palpation, percussion, auscultation and by the help of other instruments. These changes are nothing but pathological changes because they are the results of deviation from normal – the out-come of the deranged vital force.
Thus we see that the administration of drugs in healthy individuals alters the vital force and we get symptoms both subjective and objective. Both are the results of altered vital force. Similarly diseases also produce both subjective symptoms and objective findings. If the principle of Homoeopathy is “Similia Similibus Curenteur”, we must take into consideration these objective symptoms also – because they form part and parcel of the effect of deranged vital force both by drugs and by diseases. Otherwise “our position would be like a machinist who undertook to build a machine when he did not know how the parts are fitted together.”
Orthodox homoeopaths, however, say that “symptoms are indications of alteration in function or in the nutrition of a part or parts of the body and that we can know what changes are taking place through symptoms only. Therefore if one begins to talk about an altered tissue, he at once pollutes homoeopathy. It is both true and false. It is true if we take this altered tissue alone.
It is not true if we take this altered tissue as a manifestation of the change in the vital force. We can not have the totality of the effect of a drug on the system until we know the pathological changes produced therein, otherwise we would be mere symptomatist – certainly a term of reproach. We can find twenty drugs with precisely the same symptoms. How would we decide between them? Apparently they are all identical but not in their general action. How is the general action found? By the study of the drug as a whole.”
Suppose a patient comes with a low back pain. If we consult the Repertory we may find some about 50 drugs for low back pain. How to choose between them? If we have a thorough knowledge of pathology we can at once proceed to find out the pathological processes through which the alteration in the vital force is manifested. Thus we can then enquire about the constitution whether any rheumatic diathesis is present or not, can examine the kidney, can examine the generative organs in case of females or have an Xray photograph of the vertebrae.
If the pain be due to some retroverted uterus, only correction of the retroposition of the uterus either by medicine or mechanical appliance will remove the pain. Similarly if the pain be due to some kidney lesion we are likely to get better results from medicines which will have action on kidneys together with satisfying the nature and modality of pain than from medicines prescribed depending solely on the latter.
But I must warn the readers, at the same time, that by this I do not mean that we should go too deep into pathology and give prime importance to it. Bryonia, because it affects serous membranes, can not be given empirically in all affections of serous membranes. Baptisia, because in healthy individuals it produces symptoms like typhoid, can not be given empirically in all cases of typhoid; we must look for totality. On the other hand, what I aim at is that pathology forms a part & parcel of the effects of drugs or diseases in the system and that we must give proper importance to the pathological changes for the determination of totality of a case.
I shall now give a few practical illustrations:-
Case No. I. A lady of 40. I was consulted for repeated haemoptysis. Patient was found to be in semi-erect position with much dyspnoea – could not lie down. The symptoms then collected were:-
(2) Short, dry cough as soon as the patient lies down; amelioration on sitting up.
(3) Dyspnoea – wants free air but can not tolerate fanning in front of her face.
(4) Jugular veins throbbing. (5) Patient flabby. (6) Much head- sweating. (7) Suffering from acidity. (8) Thirst normal.
Heart was examined, it was found to be much dilated. The whole case was clear. The haemoptysis was due to pulmonary congestion as a result of back pressure from heart. Heart was dilated – ventricles could not pump out the blood they were receiving. So there was stagnation in both the auricles, thence to lungs and main veins respectively – thus explaining the congestion of lungs & pulsation in jugular veins.
Depending on this pathology Veratrum viride 6, 4 doses every 4 hours were given. After 4 doses the haemoptysis stopped, cough was practically nil and the patient was much better. Veratrum v. has got a very strong action on lungs producing congestion there. In this disease pulmonary congestion was the prime factor and so Veratrum was given. Before Veratrum other remedies such as Laurocerasus, Ipecac, Lachesis etc. depending on symptoms were tried but they all utterly failed.
Here it should be noted that I did not depend only on pathology, because there are other drugs which produce pulmonary congestion. But Veratrum v. was chosen because in addition to pulmonary congestion, it also covers haemoptysis, orthopnoea etc.
The above case is a clear illustration showing that pathological knowledge sometimes exerts a good deal of importance; nay, the sole important factor in the matter of selecting drugs.
But sometimes the reverse may be the case as is illustrated by the following:-
A child aged 3, suffering from a continued type of temperature, ranging from 99 to 100 degree. Case was examined and the symptoms collected were:-
(1) Fever. (2) Constipation. (3) Tongue coated thickly. (4) Excessive thirst. (5) Absolute anorexia; vomits out whatever is given; the only thing which he took with relish was hot milk. (6) Much mental irritability. (7) Excessive weakness. (8) Liver much enlarged.
Evidently it was a case of infantile liver – the fever, constipation, tongue all being due to deranged liver. From the apparent totality and from pathology either Antim crude or Chelidonium would have been the suggested remedy. But the prostration was very marked; along with that there was constant moaning; suggesting a constant mental restlessness. Depending on this irritable weakness together with this mental restlessness. Ars. alb. 30, 4 doses every 4 hours were given.
After 4 doses fever was off, mental condition much calm and quiet, no vomiting after food and the child became much cheerful.
In this case, the totality was expressed by the symptoms – “excessive weakness and mental irritability”. They were so very prominent at that particular time as to over-rule the pathology which was responsible for the chronic fever, digestive troubles and others.
Another practical illustration will substantiate my statement that pathology is equally necessary as symptomatology.
A case of uterine haemorrhage. – At the time of examination the following symptoms were marked:
(1) Profuse, horrible haemorrhage from uterus
(2) EXcessive unquenchable thirst.
(3) Constant nausea, very troublesome. There were other symptoms also but importance were not given to them.
Here two drugs are suggested – Ipecac and Phosphorus. Phosphorus is apparently more indicated because it covers all the symptoms nicely. Herein comes the importance of pathological knowledge. A symptomatist would have surely prescribed phosphorus. But a little knowledge of pathology would at once suggest Ipecac; because in this particular case, the excessive thirst is not at all an important symptom. The patient had been suffering from such a horrible type of haemorrhage that one could easily imagine what a vast amount of water had been drained out from the system – so there must be excessive thirst as a natural consequence to replenish the fluid lost. Thus the symptom of thirst was not at all an important symptom.
Next we have haemorrhage and constant nausea. This is more covered by Ipecac. Ipecac 200 was given at intervals of 2 hrs. After 2 doses nausea disappeared and haemorrhage almost stopped and the patient was saved from sure death.